Treatment of endometriosis

Women with endometriosis are confronted with one or both of two major problems: endometriosis-associated pain and infertility. Although endometriosis is a benign gynaecological disorder, its treatment is complex and often frustrating due to the progressive character and high recurrence rates of endometriosis.

Endometriosis should be viewed as a chronic disease that re­quires a lifelong management with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures (61). Treatment of endometriosis is very different depending on whether the patient has pain, infertility, or both. It is therefore important to individualize the treatment, with attention to the patient's symptoms and wishes, the impact of the disease, and the effect of treatment on the patient's life.

Treatment of endometriosis should ideally eradicate endometri­osis rather than merely relieving its symptoms. However, the cur­rently available medications result in endometriosis suppression rather than cytoreduction and attempt to achieve two main object­ives: relief of symptoms (pain) for prolonged periods and prevention of disease progression (61). There is strong evidence that suppres­sion of ovarian function reduces pain associated with endometriosis and currently combined oral contraceptives (COCs), progestogens, antiprogestogens, gonadotropin-releasing hormone (GnRH) agon­ists, and aromatase inhibitors are in clinical use. There is no evi­dence that indicates the superiority of one product to the other, but side effects and cost profiles differ (61). Hence, it is recommended that clinicians take patient preferences, side effects, costs, and avail­ability into consideration when choosing hormonal treatment for endometriosis-associated pain (2). In contrast to medical treatment, surgical management has the possibility of eliminating the disease by excision or ablation and restoration of the normal pelvic anatomy can be obtained.